nep-hea New Economics Papers
on Health Economics
Issue of 2012‒04‒03
fourteen papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Dynamic Wage and Employment Effects of Elder Parent Care By Meghan Skira
  2. Spillover Effects of Drug Safety Warnings on Health Behavior By Daysal, N. Meltem; Orsini, Chiara
  3. Does Uninsurance Affect the Health Outcomes of the Insured? Evidence from Heart Attack Patients in California By Daysal, N. Meltem
  4. The Impact of Colombia's Pension and Health Insurance Systems on Informality By Calderón-Mejía, Valentina; Marinescu, Ioana E.
  5. HIV, Wages, and the Skill Premium By Marinescu, Ioana E.
  7. The effect of working conditions on teachers’sickness absence By Marte Rønning
  8. Estimating the economic burden of cancer at a tertiary public hospital: A Study at the All India Institute of Medical Sciences By Bidhu Kalyan Mohanti et al; Abhiroop Mukhopadhyay; Sanghamitra Das; Kuldeep Sharma; Soumitra Dash
  9. Public-Private Mix of Health Expenditure: A Political Economy Approach and A Quantitative Exercise By Shuyun May Li; Solmaz Moslehi; Siew Ling Yew
  10. Health Outcomes and Socio-Economic Status Among the Elderly in China: Evidence from the CHARLS Pilot By James P. Smith; John Strauss; Xiaoyan Lei; Albert Park; Yan Shen; James P. Smith; Zhe Yang; Yaohui Zhao
  11. Determinants of Health Professionals’ Migration in Africa By Simplice A , Asongu
  12. Globalization and health worker crisis: what do wealth-effects tell us? By Simplice A, Asongu
  13. Education, Health and Mortality: Evidence from a Social Experiment By Costas Meghir; Mårten Palme; Emilia Simeonova
  14. Limited Life Expectancy, Human Capital and Health Investments: Evidence from Huntington Disease By Emily Oster; Ira Shoulson; E. Ray Dorsey

  1. By: Meghan Skira (Boston College)
    Abstract: This paper formulates and estimates a dynamic discrete choice model of elder parent care and work to analyze how caregiving affects a woman’s current and future labor force participation and wages. Intertemporal tradeoffs, such as decreased future earning capacity due to a current reduction in labor market work, are central to the decision to provide care. The existing literature, however, overlooks such long-term considerations. I depart from the previous literature by modeling caregiving and work decisions in an explicitly intertemporal framework. The model incorporates dynamic elements such as the health of the elderly parent, human capital accumulation and job offer availability. I estimate the model on a sample of women from the Health and Retirement Study by efficient method of moments. The estimates indicate that intertemporal tradeoffs matter considerably. In particular, women face low probabilities of returning to work or increasing work hours after a caregiving spell. Using the estimates, I simulate several government sponsored elder care policy experiments: a longer unpaid leave than currently available under the Family and Medical Leave Act of 1993; a paid work leave; and a caregiver allowance. The leaves encourage more work among intensive care providers since they guarantee a woman can return to her job, while the caregiver allowance discourages work. A comparison of the welfare gains generated by the policies shows that half the value of the paid leave can be achieved with the unpaid leave, and the caregiver allowance generates gains comparable to the unpaid leave.
    Keywords: Informal care, employment, dynamic discrete choice, structural estimation, Fam- ily and Medical Leave Act
    JEL: J14 J18 J22 C51
    Date: 2012–03–27
  2. By: Daysal, N. Meltem (Tilburg University); Orsini, Chiara (Università Ca’ Foscari di Venezia)
    Abstract: We examine the impact of new medical information on drug safety on preventive health behavior. We exploit the release of the findings of the Women's Health Initiative Study (WHIS) – the largest randomized controlled trial of women's health – which demonstrated in 2002 that long-term Hormone Replacement Therapy increases the risk of heart attacks, stroke, blood clots and breast cancer among healthy post-menopausal women. Because hormone replacement is a therapy exclusive to women, we estimate the spillover effects of the WHIS findings on health behavior by means of a difference-in-differences methodology using men of similar ages as the control group. Using data from the Behavioral Risk Factor Surveillance System for 1998-2007, we find statistically significant small negative spillovers on post-menopausal women's likelihood of having an annual checkup and choice of a healthy diet, as proxied by daily fruit consumption. Our results also indicate that the observed spillover effects of drug safety on health behavior were entirely driven by the less educated. These findings suggest that policies aimed at raising awareness on the safety of medications may have unintended spillover effects on health behavior and that these spillovers may contribute to the existing health disparities by education.
    Keywords: spillovers, preventive behavior, health disparities, health production
    JEL: I10 I12 I14 I18
    Date: 2012–03
  3. By: Daysal, N. Meltem (Tilburg University)
    Abstract: In this paper, I examine the impact of uninsured patients on the health of the insured, focusing on one health outcome – the in-hospital mortality rate of insured heart attack patients. I employ panel data models using patient discharge and hospital financial data from California (1999-2006). My results indicate that uninsured patients have an economically significant effect that increases the mortality rate of insured heart attack patients. I show that these results are not driven by alternative explanations, including reverse causality, patient composition effects, sample selection or unobserved trends and that they are robust to a host of specification checks. My results also indicate that the primary channel for the observed spillover effects is increased hospital uncompensated care costs. Although data limitations constrain my capacity to check how hospitals change their provision of care to insured heart attack patients in response to reduced revenues, the evidence I have suggests a modest increase in the quantity of cardiac services without a corresponding increase in hospital staff.
    Keywords: uninsurance, spillovers, heart attack mortality, hospitals
    JEL: I10 I11 I18
    Date: 2012–03
  4. By: Calderón-Mejía, Valentina (University of Chicago); Marinescu, Ioana E. (Harris School, University of Chicago)
    Abstract: Social protection systems in developing countries are typically composed of a bundle of benefits, the major ones being health insurance and pensions. Benefit bundling may increase informality and decrease welfare. Indeed, if some of the benefits are valued at substantially less than their cost, workers may choose to forego all benefits, even though some other benefits are valued at or above their cost. We examine the impact of benefit bundling using a series of Colombian reforms. The key reform is the unification of the payment systems for health and pension, which made it more difficult to contribute differently to the one plan versus the other. Using the progressive roll-out of the unified payment system by firm size, we show that benefit bundling increases both full formality and full informality by about 1 percentage point. The increase in full formality is concentrated among salaried workers in small to medium firms, while the increase in full informality is concentrated among independent workers.
    Keywords: informal sector, pensions, health insurance, social protection, Colombia
    JEL: I11 I18 O17
    Date: 2012–03
  5. By: Marinescu, Ioana E. (Harris School, University of Chicago)
    Abstract: The HIV epidemic has dramatically decreased labor supply among prime-age adults in sub-Saharan Africa. Using within-country variation in regional HIV prevalence and a synthetic panel, I find that HIV significantly increases the capital-labor ratio in urban manufacturing firms. The impact of HIV on average wages is positive but imprecisely estimated. In contrast, HIV has a large positive impact on the skill premium. The impact of HIV on the wages of low skilled workers is insignificantly different from 0, and is strongly dampened by competition from rural migrants. The HIV epidemic disproportionately increases the incomes of high-skilled survivors, thus increasing inequality.
    Keywords: labor supply, wages, health, AIDS, HIV, development
    JEL: J22 I15 J31
    Date: 2012–03
  6. By: Asae Ueda Author_Email: (Waseda University, Japan); Atsushi Ogihara (Waseda University, Japan); Manabu Yamaji (Waseda University, Japan); Hiroaki Mitani (Japan Internet Medical Association)
    Keywords: Guidelines, healthcare Information, Internet
    JEL: M0
    Date: 2011–06
  7. By: Marte Rønning (Statistics Norway)
    Abstract: This paper investigates the effect of working conditions on the amount of teachers’sickness absence in Norway. Exploiting intertemporal variation within teachers who have not changed schools, the findings indicate that teachers lower their amount of sickness absence if the school’s resource use increases. Increased workload and permanent employment contract are associated with higher sickness absence. When stratifying on teachers’age, increased workload appears to have a larger impact on old teachers.
    Keywords: Teachers; absence; working conditions
    JEL: I10 I20 J28
    Date: 2012–03
  8. By: Bidhu Kalyan Mohanti et al (All India Institute of Medical Sciences); Abhiroop Mukhopadhyay (Indian Statistical Institute, New Delhi); Sanghamitra Das (Indian Statistical Institute, New Delhi); Kuldeep Sharma (Medanta-the Medi City); Soumitra Dash (Utkal University)
    Abstract: This report is based on a prospective study which attempted to estimate the cost of treatment borne by the cancer patients at an academic tertiary public hospital. There is a lack of information about the financial burden of major illness like cancer on patient and their families. An understanding of the out-of pocket expenditures required for cancer care can improve the health care delivery process in India, both for the patients and families on one side, and the health professionals and administrators on the other side. This study estimated the expenditures done by the surveyed patients for diagnosis and initial cancer-directed treatments, as direct and indirect costs. The sampled cancer patients have monthly per capita income (MPCI) of IRS 1749(0-25,000). The economic burden of cancer therapy calculated as mean (average) costs to patient amounted to IRS. 36,812 and it consisted of: IRS 14,597 spent before coming to the hospital, IRS 14,031 at the hospital, and IRS 8,184 during the prolonged period of radiotherapy course. Out of the one million newly diagnosed cancer patients per year in India, nearly 50 percent are suitable for curative aim cancer-directed therapy. It will be a highly justifiable approach to make financial provision for those cancer patients who can not meet the treatment costs and may be denied the benefits of cancer care.
    Date: 2011–07
  9. By: Shuyun May Li; Solmaz Moslehi; Siew Ling Yew
    Abstract: This paper constructs a simple overlapping generations model to examine how the choice of public and private health expenditure is affected by preferences and economic factors under majority voting. In the model, agents with heterogeneous income decide how much to consume, save, and invest in private health care, and vote for the income tax to be used to finance public health. Agents.survival probabilities are endogenously determined by a CES composite of public and private health expenditure. For the two special cases that public and private health are complements or perfect substitutes, we show that the voting equilibrium is unique and locally stable. For the general case, we calibrate the model to Canadian data to conduct a quantitative analysis. Our results suggest that the public-private mix of health expenditure is quite sensitive to the degree of substitutability between private and public health and the relative effectiveness of public and private health. Using a sample of advanced democratic countries, we further infer these two parameters and construct the shares of public health in total health expenditure for each country, and find that the predicted values match the data quite well.
    Keywords: Public-private mix, Health expenditure, Majority voting, Overlapping generations model
    JEL: D7 H51 I1
    Date: 2012–03
  10. By: James P. Smith; John Strauss; Xiaoyan Lei; Albert Park; Yan Shen; James P. Smith; Zhe Yang; Yaohui Zhao
    Abstract: This paper is concerned with measuring health outcomes among the elderly in Zhejiang and Gansu provinces, China, and examining the relationships between different dimensions of health status and measures of socio-economic status (SES). The authors use the China Health and Retirement Longitudinal Study (CHARLS) pilot data to document health conditions among the elderly in Gansu and Zhejiang provinces, where the survey was fielded. They use a very rich set of health indicators that include both self-reported measures and biomarkers. They also examine correlations between these health outcomes and two important indicators of socioeconomic status (SES): education and log of per capita expenditure (log pce), their preferred measure of household resources. While there exists a very large literature that examines the relationships between SES and health measures, little has been done on Chinese data to see whether correlations reported in many other countries are replicated in China, particularly so for the aged. In general education tends to be positively correlated with better health outcomes, as it is in other countries. However, unmeasured community influences turn out to be highly important, much more so than one usually finds in other countries. While it is not yet clear which aspects of communities matter and why they matter, they set up an agenda for future research on this topic. They also find a large degree of under-diagnosis of hypertension, a major health problems that afflicts the aged. This implies that the current health system is not well prepared to address the rapid aging of the Chinese population, at least not in Gansu and Zhejiang.
    Date: 2010–08
  11. By: Simplice A , Asongu
    Abstract: How do economic prosperity, health expenditure, savings, price-stability, demographic change, democracy, corruption-control, press-freedom, government effectiveness, human development, foreign-aid, physical security, trade openness and financial liberalization play-out in the fight against health-worker crisis when existing emigration levels matter? Despite the acute concern of health-worker crisis in Africa owing to emigration, lack of relevant data has made the subject matter empirically void over the last decades. This paper assesses the theoretical postulations of the WHO report on determinants of health-worker migration. Findings provide a broad range of tools for the fight against health-worker brain-drain. As a policy implication, blanket emigration-control policies are unlikely to succeed equally across countries with different levels of emigration. Thus to be effective, immigration policies should be contingent on the prevailing levels of the crisis and tailored differently across countries with the best and worst records on fighting health worker emigration.
    Keywords: Welfare; Health; Human Capital; Migration
    JEL: F22 O15 J24 D60 I10
    Date: 2012–03–26
  12. By: Simplice A, Asongu
    Abstract: Owing to lack of relevant data on health human resource migration, the empirical dimension of the health-worker crisis debate has remained void despite abundant theoretical literature. A health worker crisis is overwhelming the world. Shortages in health professionals are reaching staggering levels in many parts of the globe. This paper complements existing literature by empirically investigating the WHO hypothetical determinants of health-worker migration in the context of globalization when income-levels matter. In plainer terms, the work explores how the wealth of exporting countries play-out in the determinants of HHR emigration. We assess the determinants of emigration in the health sector through-out the conditional distribution of health human resource emigration. Findings provide very targeted policy implications based on income-levels and existing emigration levels for both physician and nurse worker crises. Beside specific policy recommendations, we also outlined broad policy measures for source-countries, recipient-states and regional(international) institutions.
    Keywords: Welfare; Health; Human Capital; Migration
    JEL: F22 O15 J24 D60 I10
    Date: 2012–03–26
  13. By: Costas Meghir; Mårten Palme; Emilia Simeonova
    Abstract: We study the effect of a compulsory education reform in Sweden on adult health and mortality. The reform was implemented by municipalities between 1949 and 1962 as a social experiment and implied an extension of compulsory schooling from 7 or 8 years depending on municipality to 9 years nationally. We use detailed individual data on education, hospitalizations, labor force participation and mortality for Swedes born between 1946 and 1957. Individual level data allow us to study the effect of the education reform on three main groups of outcomes: (i) mortality until age 60 for different causes of death; (ii) hospitalization by cause and (iii) exit from the labor force primarily through the disability insurance program. The results show reduced male mortality up to age fifty for those assigned to the reform, but these gains were erased by increased mortality later on. We find similar patterns in the probability of being hospitalized and the average costs of inpatient care. Men who acquired more education due to the reform are less likely to retire early.
    JEL: I12 I18 I21
    Date: 2012–03
  14. By: Emily Oster; Ira Shoulson; E. Ray Dorsey
    Abstract: One of the most basic predictions of human capital theory is that life expectancy should impact human capital investment. Limited exogenous variation in life expectancy makes this difficult to test, especially in the contexts most relevant to the macroeconomic applications. We estimate the relationship between life expectancy and human capital investments using genetic variation in life expectancy driven by Huntington disease (HD), an inherited degenerative neurological disorder with large impacts on mortality. We compare investment levels for individuals who have ex ante identical risks of HD but learn (through early symptom development or genetic testing) that they do or do not carry the genetic mutation which causes the disease. We find strong qualitative support: individuals with more limited life expectancy complete less education and less job training. We estimate the elasticity of demand for college completion with respect to years of life expectancy of 0.40. This figure implies that differences in life expectancy explain about 10% of cross-country differences in college enrollment. Finally, we use smoking and cancer screening data to test the corollary that health capital is responsive to life expectancy.
    JEL: I15 I25 J24
    Date: 2012–03

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